Community-based Health Data Cooperatives Towards Improving the Immigrant Community Health: A Scoping Review to Inform Policy and Practice.

BACKGROUND: In the case of immigrant health and wellness, data are the key limiting factor, where comprehensive national knowledge on immigrant health and health service utilisation is limited. New data and data silos are an inherent response to the increase in technology in the collection and storage of data. The Health Data Cooperative (HDC) model allows members to contribute, store, and manage their health-related information, and members are the rightful data owners and decision-makers to data sharing (e g. research communities, commercial entities, government bodies). OBJECTIVE: This review attempts to scope the literature on HDC and fulfill the following objectives: 1) identify and describe the type of literature that is available on the HDC model; 2) describe the key themes related to HDCs; and 3) describe the benefits and challenges related to the HDC model. METHODS: We conducted a scoping review using the five-stage framework outlined by Arskey and O'Malley to systematically map literature on HDCs using two search streams: 1) a database and grey literature search; and 2) an internet search. We included all English records that discussed health data cooperative and related key terms. We used a thematic analysis to collate information into comprehensive themes. RESULTS: Through a comprehensive screening process, we found 22 database and grey literature records, and 13 Internet search records. Three major themes that are important to stakeholders include data ownership, data security, and data flow and infrastructure. CONCLUSIONS: The results of this study are an informative first step to the study of the HDC model, or an establishment of a HDC in immigrant communities. KEY WORDS: community health, health data, cooperative, and citizen data empowermen.

Patients' and Parents' Valuation of Fluoride.

PURPOSE: This study aimed to elicit willingness to pay (WTP) values for fluoride varnish application from participants using the publically-funded health services in Brazil and the UK, and to identify differences in the variables impacting these values. A secondary aim was to compare WTP values from parents for their own preventive treatment and their child's. MATERIALS AND METHODS: This was a cross-sectional analysis of quantitative data collected from participants attending routine dental appointments. The clinics were hosted by the Pontifical Catholic University of Rio Grande do Sul (PUCRS), Brazil and Newcastle Dental Hospital, UK. RESULTS: The mean WTP for Brazilian adults was R$60.37 (=£15.97). WTP was highly variable and factors affecting it were difficult to identify. UK parents valued fluoride varnish at mean values of £28.21 and £28.12 for themselves and their child, respectively. Regression modelling found those with higher incomes had higher WTP in both samples. In the UK, parental and child WTP increased when parents had higher self-perceived need for dental treatment, had experienced recent dental pain, or their child had received restorations in the last 2 years. CONCLUSIONS: WTP for fluoride varnish varied dramatically between individuals. In both countries, it was difficult to predict this variance, as factors which would likely impact upon on WTP had a limited effect and were sometimes counter-intuitive. WTP values for a parent and their child were not statistically significantly different.

Use of the surgical Apgar score to guide postoperative care.

INTRODUCTION: The surgical Apgar score (SAS) can predict 30-day major complications or death after surgery. Studies have validated the score in different patient populations and suggest it should be used to objectively guide postoperative care. We aimed to see whether using the SAS in a decisive approach in a future randomised controlled trial (RCT) would be likely to demonstrate an effect on postoperative care and clinical outcome. METHODS: A total of 143 adults undergoing general/vascular surgery in 9 National Health Service hospitals were recruited to a pilot single blinded RCT and the data for 139 of these were analysed. Participants were randomised to a control group with standard postoperative care or to an intervention group with care influenced (but not mandated) by the SAS (decisive approach). The notional primary outcome was 30-day major complications or death. RESULTS: Incidence of major complications was similar in both groups (control: 20/69 [29%], intervention: 23/70 [33%], p=0.622). Immediate admissions to the critical care unit was higher in the intervention group, especially in the SAS 0-4 subgroup (4/6 vs 2/7) although this was not statistically significant (p=0.310). Validity was also confirmed in area under the curve (AUC) analysis (AUC: 0.77). CONCLUSIONS: This pilot study found that a future RCT to investigate the effect of using the SAS in a decisive approach may demonstrate a difference in postoperative care. However, significant changes to the design are needed if differences in clinical outcome are to be achieved reliably. These would include a wider array of postoperative interventions implemented using a quality improvement approach in a stepped wedge cluster design with blinded collection of outcome data.

Solid fuel use is a major risk factor for acute coronary syndromes among rural women: a matched case control study.

OBJECTIVES: Almost half of the world's population uses solid fuel for cooking, exposing women to high levels of particulate pollution in indoor air. The risk of acute coronary syndrome (ACS) was assessed among rural women, according to their use of solid fuel. STUDY DESIGN: Matched case control study. METHODS: Data were collected at a public tertiary care hospital in a rural district of Pakistan. Seventy-three women with ACS were compared with controls, individually matched for sex and age (± 5 years), who were admitted to hospital for other reasons. Fuels used for cooking and exposures to potentially confounding variables were ascertained through a questionnaire administered at interview and measurement of height and weight. Conditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS: After adjustment for potential confounding factors, current use of solid fuel was strongly associated with ACS (OR 4.8, 95% CI: 1.5-14.8), and risk was lowest in women who had last used solid fuel more than 15 years earlier. The population attributable fraction for ACS in relation to current use of solid fuel was 49.0% (95% CI: 41.3%-57.4%). CONCLUSIONS: These findings support the hypothesis that indoor air pollution from use of solid fuel is an important cause of ACS. Our study demonstrates the feasibility of case-control studies in rural populations of women to address this question, and is an encouragement to larger and statistically more powerful investigations.

Evaluation of blood Bisphenol A contents: a case study / Evaluación de las concentraciones de Bisfenol A en la sangre: estudio de caso

OBJECTIVE: It has been recently reported that Bisphenol A (BPA) may leach out into food, beverages and water samples from the plastic ware in which it is stored. Serious health hazards have been reported from BPA. The purpose of this study is to assess the BPA contents in blood and to assess the risk of cancer. METHOD: A total of 100 individuals were selected for study according to the following five age groups: 5-10, 11-20, 21-30, 31-40 and 41-50 years. They were then further divided into normal and diseased. Age, gender, education, source of drinking water, type of food, smoking habit, any exposure to chemicals and history of cancer were elicited during interview. Blood samples were collected and processed for analysis using reversed phase-high performance liquid chromatography (rp-HPLC) in isocratic mode. The mobile phase consisted of acetonitrile and water (1:1) at a flow-rate of 1 ml min-1. RESULTS: Bisphenol A contents found in blood samples of all age groups ranged from 1.53-3.98 (mean = 2.94, SD = 0.9). P-values, for the exposed people and those having a history of cancer, were < 0.05 showing a significant relationship between BPA and cancer. The United States Environmental Protection Agency (US EPA) has established a reference dose of 50 µg/L. Odd ratios and relative risk for smoking habit were < 1 while for all others they were > 1. CONCLUSION: It was concluded from the study that people using bottled water, packaged food, having a history ofcancer and who had been exposed to any type ofchemicals are at higher risk ofdisease.

OBJETIVO: Se ha reportado recientemente que el bisfenol A (BPA) puede filtrarse a alimentos, bebidas y agua, a partir de los recipientes plásticos en que aquellos se almacenan. En tal sentido, se han reportado serios casos de riesgo para la salud a causa del BPA. El propósito de este estudio es evaluar la concentración de BPA en sangre, y el consiguiente riesgo de enfermedades cancerosas. MÉTODO: Un total de 100 individuos fueron seleccionados para el estudio, de acuerdo con los siguientes cinco grupos etarios: 5-10, 11-20, 21-30, 31-40 y 41-50 años. Dichos grupos fueron divididos entonces sobre la base de sujetos normales frente a enfermos. En la entrevista se tomó nota de la edad, el género, la educación, la fuente de agua potable, el tipo de comida, el hábito de fumar, cualquier exposición a productos químicos, así como la historia de cáncer. Las muestras de sangre fueron recogidas y procesadas para realizar análisis, utilizando cromatografía líquida de alta eficacia de fase reversa (rp-HPLC) en modo isocrático. La fase móvil consistió en acetonitrilo y agua (1:1) con una tasa de flujo de 1 ml min-1. RESULTADOS: Las concentraciones de bisfenol-A halladas en las muestras de sangre de todos los grupos etarios, oscilaron de 1.53 - 3.98 (M = 2.94, SD = 0.9). Los valores P para las personas expuestas y con una historia de cáncer, fueron < 0.05, indicando una relación directa entre el BPA y el cáncer. La Agencia de Protección Ambiental de los Estados Unidos (US EPA) ha establecido una dosis de referencia de 50 µg/L. El cociente de probabilidades (odd ratios) y el riesgo relativo con respecto al hábito de fumar fueron < 1 mientras que para todos los otros casos otros fueron >1. CONCLUSIÓN: A partir del estudio se concluye que las personas que usan agua embotellada, alimentos empaquetados, así como las personas que poseen una historia de cáncer, y los individuos que habían estado expuestos a cualquier tipo de productos químicos, presentan un mayor riesgo de enfermedad.

Implementing a public-private mix model for tuberculosis treatment in urban Pakistan: lessons and experiences.

SETTING: Six towns of Karachi, Pakistan. OBJECTIVES: 1) To strengthen the capacity of general practitioners (GPs) in providing tuberculosis (TB) treatment through DOTS; and 2) to enhance collaboration between the public and private sectors in TB management and case reporting. DESIGN: A quasi-experimental study design was adopted to ensure enrolment of TB patients through trained GPs with the support of laboratory networks and to improve the case detection rate. RESULTS: The following challenges were faced during implementation of the model in urban settings: no systematic list of GPs was available; the majority of the GPs were untrained health practitioners working in squatter settlements, where formally trained GPs are most needed; the motivation of GPs with high patient loads is very low; and access to a laboratory is difficult. Of 35 patients enrolled in the first quarter (third quarter 2009), 87% completed their treatment successfully. CONCLUSION: Public-private mix (PPM) DOTS is feasible in the cities of Pakistan. However, the cost, time and effort required to establish the programme is higher than in many other developing countries.

Evaluation of blood bisphenol A contents: a case study.

OBJECTIVE: It has been recently reported that Bisphenol A (BPA) may leach out into food, beverages and water samples from the plastic ware in which it is stored. Serious health hazards have been reported from BPA. The purpose of this study is to assess the BPA contents in blood and to assess the risk of cancer. METHOD: A total of 100 individuals were selected for study according to the following five age groups: 5-10, 11-20, 21-30, 31-40 and 41-50 years. They were then further divided into normal and diseased. Age, gender, education, source of drinking water, type of food, smoking habit, any exposure to chemicals and history of cancer were elicited during interview. Blood samples were collected and processed for analysis using reversed phase-high performance liquid chromatography (rp-HPLC) in isocratic mode. The mobile phase consisted of acetonitrile and water (1:1) at a flow-rate of 1 ml min-1. RESULTS: Bisphenol A contents found in blood samples of all age groups ranged from 1.53-3.98 (mean = 2.94, SD = 0.9). P-values, for the exposed people and those having a history of cancer, were < 0.05 showing a significant relationship between BPA and cancer The United States Environmental Protection Agency (US EPA) has established a reference dose of 50 microg/L. Odd ratios and relative risk for smoking habit were < 1 while for all others they were > 1. CONCLUSION: It was concluded from the study that people using bottled water, packaged food, having a history of cancer and who had been exposed to any type of chemicals are at higher risk of disease.

Percutaneous nephrolithotomy for removal of a calcified intra-renal artillery shell fragment.

Residual metallic fragments after intra-abdominal penetrating injuries due to fragments of artillery shells are generally inert, although they may rarely re-activate. The authors present a case where such a fragment presented as a renal stone 17 years after injury. The literature was reviewed and the initial difficulties with the radiological diagnosis, as well as treatment approaches and post-operative findings are discussed in the light of existing reports. An additional challenge arose as the authors working in a tertiary endourology centre attempted to remain as minimally invasive as possible, but were limited by the very nature of the foreign body.

Mammary gland 1,25-dihydroxyvitamin D3 receptor content during pregnancy and lactation.

The purpose of this study was to establish the time course and magnitude of changes in 1,25-dihydroxy-vitamin D receptor activity in rat mammary gland during pregnancy and lactation and to correlate these changes with casein production and alkaline phosphatase activity. Marked increases in both 1,25-dihydroxyvitamin D3 receptor and alkaline phosphatase activities were seen towards the end of pregnancy but the time course of these changes was not synchronous. Receptor activity was first detectable at 11 days of pregnancy with a marked rise in receptor levels at 3 days post-partum. Changes in alkaline phosphatase activity more closely correlated with casein production and peak activity was observed at the time of parturition. We conclude that 1,25-dihydroxyvitamin D3 receptor content increases during pregnancy and lactation and may be involved in maintaining milk calcium concentration.

Further studies on the characterization of cylindrin and torin, two extrinsic proteins of the erythrocyte membrane.

The subunit composition of the high molecular weight proteins cylindrin and torin from human erythrocyte ghosts has been studied by sodium dodecyl sulphate polyacrylamide gel electrophoresis on 3 to 30% "Gradipore' polyacrylamide gradient slab gels. Torin has been shown to be a multimer of a single polypeptide of approx. Mr 20 000. Cylindrin appears to contain five polypeptides, three of which predominate, in the Mr range 22 000 to 25 000. The isoelectric points (pI) of cylindrin and torin have been determined as 4.6 and 4.8, respectively. The molecular properties of cylindrin and torin are discussed in relation to the previous studies by the authors and others on these proteins.

The subunit composition of two high molecular weight extrinsic proteins from human erythrocyte membranes.

Purified hollow cylinder (22.5 S) and torus protein (9.0 S) from human erythrocyte membranes, together with the intact membranes, have been dissociated using 2% sodium dodecyl sulphate and electrophoresed in the presence of 0.1% sodium dodecyl sulphate. The torus protein gives rise to a single subunit migrating slightly ahead of band 8 of the polypeptide profile of the intact membranes (Mr approximately 20 000) and the hollow cylinder gives rise to two main subunits, which migrate slightly behind that of the torus protein. It is clearly shown that neither protein is related to erythrocyte membrane spectrin (bands 1 + 2) or actin (band 5).

The breakdown of spectrin produced by ultrasonication.

The application of carefully controlled ultrasonication to human erythrocyte membranes (ghosts) has been found to produce a selective breakdown of the two spectrin polypeptides. This breakdown increases with the time and the intensity of ultrasonication. The 240 000 molecular weight spectrin polypeptide is slightly more susceptible to ultrasonication than the 220 000 molecular weight polypeptide. Isolated spectrin behaves in an identical manner when ultrasonicated. When highly purified samples of spectrin are ultrasonicated the progressive reduction of the molecular weight of the products with increasing time is clearly apparent.